Who Pays for Care at Home?
Following a community care assessment, a Social & Community Services Care Manager may arrange a package of services to support the person with dementia at home. The local authority may charge for services it arranges. But only the person receiving the services should be financially assessed. Charges must be reasonable, and services must not be discontinued because a person is unable to pay.
Alternatively, if a person with dementia or a carer has been assessed as needing community care services, their local authority may agree to give them money so that they can arrange and pay for these services themselves. These payments are called direct payments.
The Age Concern factsheet Paying for care and support at home explains what assistance may be available to help meet the financial cost of maintaining care at home.
It is possible for people to remain at home even when they have very high health care needs. The leaflet Guide to fully funded NHS care (PDF, 297KB) explains what happens when someone's health needs are such that it is the responsibility of the NHS to provide all of the care that they need.
Paying Care Home Fees
If someone needs to move into a care home, the local authority will assess the person's income and savings according to national criteria, details of which can be found on the Directgov Paying your care home fees page. The local authority may then fully or partially fund the care home fees, or the person may have to self-fund. For further details, see the Alzheimer's Society factsheet Paying care home fees and the Age Concern factsheet How to find a care home (Age Concern Guide).
People who have to self-fund, and live in a Nursing Home, may benefit from a slight reduction in fees due to NHS-funded nursing care. The "registered nursing care contribution" (RNCC) assessment places the resident's nursing care needs into one of three bands: high, medium and low, each of which receives a different level of NHS funding contribution. The money is paid direct to the Nursing Home. For further details, see the Alzheimer's Society factsheet NHS-funded nursing care and Age Concern factsheet Continuing NHS health care, NHS funded registered nursing care and intermediate care.
The Department of Health provides an explanation of the charging system for residential care home fees. The Alzheimer's Society has produced a factsheet on paying care home fees.
NHS Continuing Care
Some people with dementia, who have complex health needs may be eligible for full NHS Continuing Care. This is free, and not means-tested. If awarded it will meet the full cost of the person's care needs. This is commonly referred to as "NHS Continuing Care", "Continuing NHS Health Care" or "Fully Funded NHS Care".
There has recently been a great deal of discussion about who is entitled to this full funding from the National Health Service. There have been two leading court cases; the Coughlan case in 1999 and, more recently, the Grogan case in January 2006. The leaflet Guide to fully funded NHS care (PDF, 297KB) has important information about Continuing Care entitlement.
People who live in a nursing or care home may want to query whether they have been correctly assessed as not needing fully funded NHS care. Some people who live in care homes might be able to qualify for fully funded NHS care if the nature or type of their care is such that it counts as health care.
If you think you may have been wrongly assessed regarding NHS Continuing Care, there is a draft letter on page 10 of the guide (PDF, 297KB) which can be used to ask for a review of the decision about whether care should be fully funded by the NHS or not. If you would like to discuss this issue you can contact the Age Concern Policy information line on 0845 0770755.
Please note: Full NHS Continuing Care is different from the RNCC (registered nursing care contribution) outlined above.
Everyone should have an NHS Continuing Care assessment before being admitted to a Nursing Home, but it is also possible to apply for an assessment at other times (e.g. when living at home), if you think the person with dementia may meet the criteria.
Care Following Section Under Mental Health Act
Section 117 of The Mental Health Act (1983) requires statutory authorities to make arrangements for the continued care of a person who has been detained under Section 3. This care must be provided free of charge. An example of this would be when a person with dementia has been detained in hospital for treatment under Section 3 and is then discharged to a Nursing Home.
More information is available on our Mental Health Act page.
Independent Financial Advice About Funding Care
The NHFA (formerly the Nursing Home Fees Agency) provides older people, carers, and the general public with advice and information on obtaining and paying for care. Combines financial advice with complexities of local authority charging procedures, health authority responsibilities, DWP benefit entitlement, and relevant legal matters.
More information is available on the NHFA website.
You may also find Age Concern's Care Information section useful, and our Financial Advice section.
Further Information
You may be interested to look at the Age Concern factsheet Local authority assessment for community care services - Factsheet 41 and the Alzheimer's Society's explanation of the National Framework for NHS Continuing Care.
The Age Concern Factsheet Getting legal advice is useful if you find you require some form of legal advice.
